<%@ page language="java" contentType="text/html; charset=utf-8"
	pageEncoding="utf-8"%>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<%
	String path = request.getContextPath();
	String basePath = request.getScheme()+"://"+request.getServerName()+":"+request.getServerPort()+path+"/";
%>	
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<meta http-equiv="X-UA-Compatible" content="IE=7" />
<link href="<%=basePath %>mcms/themes/css/login.css" rel="stylesheet" type="text/css" />
<title>客户信息管理系统</title>
<script type="text/javascript">
<!--

//-->
// 是否预约select的change事件：是-显现预约信息层；否-不显现，并清空内容
function displayData(){
	var flag = $("#appointment option:selected").val();
     alert(flag);
	if(flag == '0' || flag == 0){
	alert("in");
		document.getElementById('dateDiv').style.display='block';
	}else{
	    document.getElementById('appointDate').value = '';
	    document.getElementById('appointmemo').value = '';
		document.getElementById('dateDiv').style.display='none';
	}
	
}
</script>

</head>
<body>
<form id="pagerForm" method="post" action="#rel#">
	<input type="hidden" name="pageNum" value="1" />
	<input type="hidden" name="numPerPage" value="${model.numPerPage}" />
	<input type="hidden" name="orderField" value="${param.orderField}" />
	<input type="hidden" name="orderDirection" value="${param.orderDirection}" /> 
</form>


<div class="pageContent">
	<form method="post" action="demo/common/ajaxDone.html" class="pageForm required-validate" onsubmit="return validateCallback(this, navTabAjaxDone);">
		
		<div class="pageFormContent" layoutH="56">
		<div class="panel collapse" defH="180" width="50%">
		<h1>客户基本信息</h1>  
		<div>
			<!-- 客户基本资料区域begin -->
			<p>
				<label>姓名：</label>
				<input name="sn" type="text" size="30" value="" class="required"  alt=""/> 
			</p>
			<p>
				<label>性别：</label>
				<select name="capital" class="combox">
					<option value="">请选择</option>
					<option value="10">男</option>
					<option value="50">女</option>
					<option value="100">不详</option>
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>年龄：</label>
				<input name="name" type="text" size="30" value="" alt=""/>
			</p>
			
			<p>
				<label>联系手机：</label>
				<input name="name" class="required" type="text" size="30" value="" alt=""/>
			</p>
			<p>
				<label>籍贯：</label>
				<input name="name" type="text" size="30" value="" alt=""/>
			</p>
			<p>
				<label>固定电话：</label>
				<input name="name" type="text" size="30" value="" alt=""/>
			</p>
			<p>
				<label>住址：</label>
				<input name="name" type="text" size="30" value="" alt=""/>
			</p>
			<p>
				<label>EMAIL：</label>
				<input name="name" type="text" size="30" value="" alt=""/>
			</p>
			<p>
				<label>联系QQ：</label>
				<input name="name" type="text" size="30" value="" alt=""/>
			</p>
			<p>
				<label>职业：</label>
				<input name="name" type="text" size="30" value="" alt=""/>
			</p>
			<!-- 客户基本资料区域end -->
		</div>
		</div>
		<!-- 客户基本资料区域begin -->
			<p>
				<label>姓名：</label>
				<input name="sn" type="text" size="30" value="" class="required"  alt=""/> 
			</p>
			<p>
				<label>性别：</label>
				<select name="capital" class="combox">
					<option value="">请选择</option>
					<option value="10">男</option>
					<option value="50">女</option>
					<option value="100">不详</option>
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>年龄：</label>
				<input name="name" type="text" size="30" value="" alt=""/>
			</p>
			
			<p>
				<label>联系手机：</label>
				<input name="name" class="required" type="text" size="30" value="" alt=""/>
			</p>
			<p>
				<label>籍贯：</label>
				<input name="name" type="text" size="30" value="" alt=""/>
			</p>
			<p>
				<label>固定电话：</label>
				<input name="name" type="text" size="30" value="" alt=""/>
			</p>
			<p>
				<label>住址：</label>
				<input name="name" type="text" size="30" value="" alt=""/>
			</p>
			<p>
				<label>EMAIL：</label>
				<input name="name" type="text" size="30" value="" alt=""/>
			</p>
			<p>
				<label>联系QQ：</label>
				<input name="name" type="text" size="30" value="" alt=""/>
			</p>
			<p>
				<label>职业：</label>
				<input name="name" type="text" size="30" value="" alt=""/>
			</p>
			<!-- 客户基本资料区域end -->
			
			<div class="divider"></div>
			
			<!-- 问诊信息区begin -->
			<p>
				<label>来院渠道：</label>
				<select name="capital" class="combox">
					<option value="">请选择</option>
					<option value="10">电话</option>
					<option value="50">网络</option> 
					<option value="100">媒体广告</option> 
					<option value="150">朋友介绍</option> 
					<option value="200">美发店介绍</option> 
					<option value="250">院内转介绍</option> 
					<option value="300">其他</option> 
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>咨询项目：</label>
				<select name="capital" class="combox">
					<option value="">请选择</option>
					<option value="10">头发移植</option>
					<option value="50">眉毛移植</option>
					<option value="3">睫毛移植</option>
					<option value="4">鬓角移植</option>
					<option value="5">胡须移植</option>
					<option value="6">体毛移植</option>
					<option value="7">胸毛移植</option>
					<option value="17">疤痕移植</option>
					<option value="8">二次修复</option>
					
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>咨询医生：</label>
				<select name="capital" class="combox">
					<option value="">请选择</option>
					<option value="10">现场医生</option>
					<option value="50">网络医生</option>
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>脱发情况：</label>
				<select name="capital" class="combox">
					<option value="">请选择</option>
					<option value="10">发迹后移</option>
					<option value="50">局部稀疏</option>
					<option value="1001">大面积稀疏</option>
					<option value="1002">M型脱发</option>
					<option value="1003">O型脱发</option>
					<option value="1004">M+O型脱发</option>
					<option value="1005">疤痕脱发</option>
					<option value="1006">斑秃</option>
					<option value="1007">普秃</option>
					<option value="1008">整体稀疏</option>
					
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>脱发时长：</label>
				<select name="capital" class="combox">
					<option value="">请选择</option>
					<option value="10">近几天</option>
					<option value="50">近几月</option>
					<option value="1001">1年内</option>
					<option value="1002">1-2年</option>
					<option value="1003">3-4年</option>
					<option value="1004">5-6年</option>
					<option value="1005">7-8年</option>
					<option value="1006">8年以上</option>
					
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>脱发级别：</label>
				<select name="capital" class="combox">
					<option value="">请选择</option>
					<option value="10">Ⅰ级</option>
					<option value="50">Ⅱ级</option>
					<option value="1001">Ⅲ级</option>
					<option value="1002">Ⅳ级</option>
					<option value="1003">Ⅴ级</option>
					<option value="1004">Ⅵ级</option>
					<option value="1005">Ⅶ级</option> 
					
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>是否有家族遗传史：</label>
				<select name="capital" class="combox">
					<option value="">请选择</option>
					<option value="10">是</option>
					<option value="50">否</option>
					
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>是否有药物治疗史：</label>
				<select name="capital" class="combox">
					<option value="">请选择</option>
					<option value="10">是</option>
					<option value="50">否</option>
					
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>是否预约：</label>
				 
				<select id="appointment" name="appointment" class="combox" onchange="">
					<option value="">请选择</option>
					<option value="0">是</option>
					<option value="1">否</option>
				</select>
				<!--  
				<a class="button" href="<%=basePath %>doctor_appointment.html?actionType=yyjz" target="dialog" rel="dlg_page9"><span>预约就诊</span></a>-->
				<span class="unit"></span>
			</p>
			<!-- 问诊信息区end -->
			
			<div class="divider"></div>
			
			<!-- 检测信息区begin -->
			<p>
				<label>是否检测：</label>
				<select name="capital" class="combox">
					<option value="">请选择</option>
					<option value="10">是</option>
					<option value="50">否</option>
					
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>头发检测（脱发区）：</label>
				<select name="capital" class="combox">
					<option value="">请选择</option>
					<option value="10">细小</option>
					<option value="50">萎缩</option>
					<option value="10">受损</option>
					<option value="10">坏死</option>
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>头皮油脂：</label>
				<select name="capital"  class="combox">
					<option value="">请选择</option>
					<option value="10">偏油</option>
					<option value="50">油性</option>
					<option value="10">中性</option>
					<option value="10">干性</option>
					<option value="10">偏干</option>
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>头发密度（供体区）：</label>
				<select name="capital" class="combox">
					<option value="">请选择</option>
					<option value="10">A</option>
					<option value="50">B</option>
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>头皮弹性：</label>
				<select name="capital" class="combox">
					<option value="">请选择</option>
					<option value="10">较好</option>
					<option value="50">一般</option>
					<option value="10">偏差</option>
				</select>
				<span class="unit"></span>
			</p>
			
			<!-- 检测信息区end -->
			
			<div class="divider"></div>
			
			<!-- 治疗方案区begin -->
			<p>
				<label>治疗方案：</label>
				<select name="capital" class="combox">
					<option value="">请选择</option>
					<option value="10">手术治疗</option>
					<option value="50">药物治疗</option>
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>技术：</label>
				<select name="capital" class="combox">
					<option value="">请选择</option>
					<option value="10">FUT</option>
					<option value="50">FUE </option>
					<option value="10">PDT</option>
					<option value="10">PDE</option>
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>种植数量：</label>
				<input name="name" type="text" size="30" value="" alt=""/>
				<span class="unit"></span>
			</p>
			<p>
				<label>单价：</label>
				<select name="capital" class="combox">
					<option value="">请选择</option>
					<option value="10">6元</option>
					<option value="50">9元 </option>
					<option value="10">10元</option>
					<option value="10">12元</option>
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>是否化验：</label>
				<select name="capital" class="combox">
					<option value="">请选择</option>
					<option value="10">是</option>
					<option value="50">否 </option>
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>化验是否正常：</label>
				<select name="capital" class="combox">
					<option value="">请选择</option>
					<option value="10">是</option>
					<option value="50">否 </option>
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>乙肝两对半：</label>
				<select name="capital" class="combox">
					<option value="">请选择</option>
					<option value="10">阴性</option>
					<option value="50">阳性</option>
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>是否建立病例：</label>
				<select name="capital" class="combox">
					<option value="">请选择</option>
					<option value="10">是</option>
					<option value="50">否</option>
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>是否预约手术：</label>
				<select name="capital" class="combox">
					<option value="">请选择</option>
					<option value="10">是</option>
					<option value="50">否 </option>
				</select>
				<span class="unit"></span>
			</p>
			<p>
				<label>预约手术日期：</label>
				<input type="text" id="appointDate" name="appointDate"  class="date" size="30" /><a class="inputDateButton" href="javascript:;">选择</a>
				<dl class="nowrap">
					<dt>备注：</dt>
					<dd><textarea id="appointmemo" name="appointmemo" cols="80" rows="2"></textarea></dd>
				</dl>
			</p>
			<!-- 治疗方案区end -->
			<div class="divider"></div>
			
		</div>
		<div class="formBar">
			<ul>
				<!--<li><a class="buttonActive" href="javascript:;"><span>保存</span></a></li>-->
				<li><div class="buttonActive"><div class="buttonContent"><button type="submit">保存</button></div></div></li>
				<li>
					<div class="button"><div class="buttonContent"><button type="button" class="close">取消</button></div></div>
				</li>
			</ul>
		</div>
	</form>
</div>


</body>
</html>